Bone marrow edema lesions in the professional runner

Background: The clinical significance of an incidental finding of bone marrow edema (BME) on MRI in professional runners is poorly understood.

Purpose: To investigate the prevalence and clinical and radiological progression of BME lesions in professional runners who consider themselves to be asymptomatic.

Study design: Case series; Level of evidence, 4.

Methods: Sixteen athletes (13 men and 3 women; mean age, 22.9 ± 2.7 years) were recruited from the Dutch National Committee middle-distance and long-distance running selection. All athletes had been injury free for the year before the study. Magnetic resonance imaging scans were obtained before the start of the season and at the end of the season. Both pubic bones, hips, knees, and ankles were scanned in a single session. Preseason and postseason Lysholm scores were obtained.

Results: Fourteen of the 16 athletes had BME lesions before the start of the season (45 BME lesions in total). Most BME lesions (69%; 31/45) were located in the ankle joint and foot. More than half of the lesions (58%; 26/45) fluctuated during the season, with new lesions occurring (20%; 9/45) and old lesions disappearing (22%; 10/45). The few clinical complaints that occurred throughout the season were not related to the presence of BME lesions.

Conclusion: Almost all asymptomatic athletes showed BME lesions, with more than half of the lesions fluctuating during the season. These data suggest that the incidental finding of a BME lesion on MRI of professional runners should not immediately be related to clinical complaints or lead to an altered training program.